Vestibular influence on cranio-cervical pain: A case report

Abstract

This case report describes a 39 year old woman with a 10 month history of right-sided temporal headaches. In addition, she experienced a ‘wobble’ feeling when rolling toward her right side and reported suboccipital pain, tinnitus and a mild visual disturbance. Objective assessment revealed she had a positional upbeat clockwise torsional nystagmus, that is, a positive Dix-Hallpike test for benign paroxysmal positional vertigo. Furthermore, manual assessment revealed right upper cervical joint dysfunction. She was treated with a four stage canalith repositioning manoeuvre for the vestibular system which abolished her ‘wobble’ symptom. Subsequently, manual therapy techniques were applied to the cervical joints and suboccipital musculature resulting in the relief of the patient’s headache, suboccipital pain and mild visual disturbance. This case report discusses the importance of considering the peripheral vestibular system in patients who present with headache and dizziness. The purpose of this case study is to highlight that the vestibular system along with cervicogenic originating symptoms of headache and visual symptoms should all be considered and assessed accordingly.